Low back pain is often called lumbago or lumbodynia. Lumbago or "lumbago" is an attack of acute low back pain, generally associated with hypothermia and exertion. Lumbago occurs in many people and is often the cause of temporary disability. Often sports injuries or sprains can be the cause of lumbago, but sometimes the factor that causes the pain to appear is not known. Lumbago is characterized by pain without radiating to the legs. Low back pain (lumbago) can appear acutely and progress gradually throughout the day. Often there is stiffness in the morning, and gradually the stiffness turns into pain syndrome. A curvature of the spine (analgesic scoliosis) is also possible as a result of muscle spasms. The pain itself can be due to a muscle spasm, which in turn is linked to other causes. It can be an overload or sprain, sports injuries, herniated discs, spondylarthrosis (spondylosis), kidney disease (infections or kidney stones). Sometimes the patient accurately determines the cause and effect relationship between the appearance of discomfort on exertion, hypothermia, but often the pain appears for no apparent reason. Sometimes back pain can appear even after sneezing, bending over, or putting on shoes. This can be facilitated by deforming diseases of the spine, such as scoliosis.
Unlike lumbago, the term lumbodynia does not mean acute pain, but subacute or chronic pain. Typically, the pain associated with lumbodynia appears gradually over several days. Pain can also occur in the morning and may decrease with physical activity. Lumbodynia is characterized by increased pain during prolonged static loads (sitting, uncomfortable body position). It is also characteristic of lumbodynia that the pain is relieved by lying down in a certain position. Patients with lumbodynia have difficulty performing routine activities such as bathing or putting on shoes due to muscle spasms. Due to the disease, there is a decrease in the volume of trunk movements (tilting forward or, to a lesser extent, tilting to the side or in extension). Due to the pain syndrome, the patient often has to change position when it is necessary to sit or stand. Unlike lumbago, muscle spasms are less pronounced and, as a rule, do not cover the entire lower back, and there are often signs of a prevalence of spasms on one side.
Causes of back pain
Back pain is a symptom. The most common causes of back pain are diseases (injuries) of muscles, bones and intervertebral discs. sometimesBack achecan be caused by diseases of the abdominal cavity, small pelvis and chest. Such pains are called reflected pains. Diseases of the abdomen (eg, appendicitis), aortic aneurysm, kidney disease (urolithiasis, kidney infection, bladder infections), infections of the pelvic organs, ovaries - all of these can occurBack ache. . . Even a normal pregnancy can lead to lower back pain due to sprains in the pelvic area, muscle spasms due to stress, and irritation of the nerves.
OftenBack acheis associated with the following diseases:
- Compression of the nerve root, which causes symptoms of sciatica and is most often caused by a herniated disc. As a rule, when the nerve root is compressed, the pain is sharp, has irradiation and impaired sensitivity in the area of nerve root innervation. A herniated disc occurs mainly as a result of disc degeneration. There is a swelling of the gelatinous part of the disc of the central cavity and pressure on the nerve roots. Degenerative processes in the intervertebral discs begin at the age of 30 years and older. But the very presence of a hernia does not always have an effect on nerve structures.
- Spondylosis - degenerative changes occur in the vertebrae themselves, bone growths (osteophytes) occur, which can affect nearby nerves, resulting in pain.
- Spinal stenosis can occur as a result of degenerative changes in the spine (spondylosis and osteochondrosis). A patient with spinal stenosis in the lumbar region may experience lower back pain radiating to both legs. Low back pain can appear due to standing or walking.
- Cauda equina syndrome. This is a medical emergency. Cauda equina syndrome occurs as a result of the compression of the elements of the cauda equina (end part of the spinal cord). A patient with cauda equina syndrome may experience pain and impaired bowel and bladder function (urinary incontinence and sluggishness). This syndrome requires urgent surgery.
- Pain syndromes such as myofascial pain syndrome or fibromyalgia. Myofascial pain syndrome is characterized by pain and stiffness at certain points (trigger points), a decrease in the volume of muscle movements in painful areas. Pain syndrome is reduced by relaxing the muscles located in the painful areas. With fibromyalgia, pain and soreness is common throughout the body. Fibromyalgia is not characterized by muscle tightness and pain.
- Bone infections (osteomyelitis) of the spine are rarely the cause of the disease.
- Non-infectious inflammatory diseases of the spine (ankylosing spondylitis) can cause stiffness and pain in the spine (including the lower back), which is especially worse in the morning.
- Tumors, most often cancerous metastases, can be a source of lower back discomfort.
- Inflammation of the nerves and, therefore, manifestations of pain (in the chest or in the lumbar region) can be caused by damage to the nerves themselves (for example, with shingles)
- Considering the variety of causes of symptoms, such as acute or subacute low back pain, it is very important to fully assess the patient and perform all necessary diagnostic procedures.
Symptoms
Pain in the lumbosacral region is the main symptom of lumbago, lumbodynia, low back pain.
- The pain may radiate to the front, side or back of the leg (lumbar ischalgia), or it may be localized only in the lumbar region (lumbago, lumbodynia).
- The sensation of pain in the lower back may intensify after exercise.
- Sometimes the pain can get worse at night or when you are sitting for a long time, such as on a long car trip.
- Perhaps the presence of numbness and weakness in the part of the leg located in the area of innervation of the compressed nerve.
For rapid diagnosis and treatment, a number of criteria (symptoms) deserve special attention:
- A recent history of injury, such as a fall from a height, a traffic accident, or similar incidents.
- The presence of minor injuries in patients over 50 years of age (for example, fall from a low height as a result of sliding and landing on the buttocks).
- History of long-term steroid use (for example, this is in patients with bronchial asthma or rheumatologic diseases).
- Any patient with osteoporosis (mainly elderly women).
- Any patient over 70 years old: at this age there is a high risk of cancer, infections and diseases of the abdominal organs, which can cause lower back pain.
- History of Oncology
- The presence of infectious diseases in the recent past
- Temperature above 100 F (37. 7 C)
- Drug use: Drug use increases the risk of infectious diseases.
- Lower back pain worsens with rest: as a rule, this nature of pain is associated with oncology or infections, and such pain can also be associated with ankylosing spondylitis (ankylosing spondylitis).
- Significant weight loss (for no apparent reason).
- The presence of any acute nerve dysfunction is a signal for urgent medical attention. For example, this is a violation of walking, dysfunction of the foot, as a rule, is a symptom of acute nerve damage or compression. Under certain circumstances, such symptoms may require emergency neurosurgery.
- Bowel or bladder dysfunction (incontinence and urinary retention) may be a sign of a medical emergency.
- Failure of recommended treatment or increased pain may also require medical attention.
The presence of any of the above factors (symptoms) is a signal to seek medical help within 24 hours.
Diagnostic
A medical history is important in making an accurate diagnosis, as a variety of conditions can cause lower back pain. The time of onset of pain, the relationship with physical exertion, the presence of other symptoms such as cough, temperature rise, bladder or bowel dysfunction, the presence of seizures, etc. A physical examination is carried out: identification of pain points, presence of muscle spasm, a study of the neurological state is carried out. If a disease of the abdominal cavity or pelvic organs is suspected, an examination is performed (ultrasound of the abdominal organs, ultrasound of the pelvic and pelvic organs, urine blood tests).
If the somatic genesis of low back pain is excluded, instrumental research methods such as x-ray, computed tomography or MRI may be prescribed.
Radiography is the initial examination method and allows you to determine the presence of changes in bone tissue and indirect signs of changes in the intervertebral discs.
Computed tomography makes it possible to visualize the presence of various changes, both in bone tissue and in soft stones (especially with contrast).
MRI is the most informative research method that can diagnose morphological changes in various tissues.
Densitometry is necessary if osteoporosis is suspected (usually in women over 50)
EMG (ENMG) is used to determine the violation of conduction along nerve fibers.
Laboratory tests are prescribed (blood tests, urine tests, blood biochemistry) mainly to rule out inflammatory processes in the body.
Pain treatment
After diagnosis and confirmation of vertebral genesis with lumbago and lumbodynia, some treatment of lower back pain is prescribed.
With acute pain, rest is required for 1-2 days. Bed rest can reduce muscle tension and muscle spasms. In most cases, when the pain syndrome is due to muscle spasm, the pain syndrome decreases within a few days without the use of drugs, only due to rest.
Medication. For pain syndrome, drugs from the NSAID group are used. COX-2 inhibitors have fewer side effects, but long-term use of these drugs also comes with some risks. Since all drugs in this group have many side effects, the intake of drugs in this group should be short-lived and under the mandatory supervision of a doctor.
Muscle relaxants can be used to relieve spasms. But the use of these drugs is effective only in the presence of a spasm.
Steroids can be used to treat pain, especially when there are signs of sciatica. But due to the presence of pronounced side effects, the use of steroids should be selective and of short duration.
Manual therapy. This technique can be very effective in the presence of muscle blockages or subluxation of the facet joints. Mobilization of the motor segments can reduce both muscle spasms and lower back pain.
Physiotherapy. There are many modern physiotherapy procedures that can both reduce pain and inflammation, improve microcirculation (eg, electrophoresis, cryotherapy, laser therapy, etc. ).
Exercise therapy. Exercise is not recommended for acute lower back pain. Connection of exercise therapy is possible after reducing the pain syndrome. In the presence of chronic pain, exercise can be very effective in strengthening the muscle corset and improving the biomechanics of the spine. Exercises should be selected only with an exercise therapy doctor, since often independent exercises can lead to increased manifestations of pain. Systematic exercise therapy, especially in the presence of degenerative changes in the spine (osteochondrosis, spondylosis), can preserve the functionality of the spine and significantly reduce the risk of pain syndromes.